Monday, October 12, 2009
Thursday, October 1, 2009
I Survived the Death Panel
I'm going to run the assumption that you are smart enough to understand that the whole "Death Panel" thing is and was a big, fat lie.
Except.
Except that sometimes, when you are dealing with a government-funded program, they force the conversation.
The situation was that Mama was involved with a Department of Aging-funded program. I don't know why, but they insisted, required and demanded that we sat down with Mama and have the talk. The Talk.
It was devastating. H didn't want to think of a time where his mother wouldn't be here. He cried, he raged, he avoided. But. But. It came down to losing benefits if we didn't complete the forms.
So we did it. It sucked, it sucked, it sucked and we did it. We talked amongst ourselves, we asked Mama.
And.
And then we knew.
So when it came to that moment, when it came time in the hospital to try 'heroic' measures, when it came to the decision or machine or death, we knew what to do. We knew what Mama wanted us to do.
She didn't want to linger. She didn't want to suffer. She didn't want to be a burden. She didn't want to be in pain.
It still sucked, by the way. And I so did not want to respect her wishes, I wanted to do anything and everything and ANYTHING to keep her around, to keep her in my life. But H stood strong, and did what she wanted.
So.
I can tell you, for a fact, that the conversation would not have happened if the United States Government had not insisted it. And I can tell you, for another fact, that it helped us, as a family, cope with the and come to terms with the severity of Mama's condition.
So, should everyone do it? Should everyone be forced to endure that level of reflection and contemplation?
You're going to have your own opinion, but (within limits) I don't see the downside of it. As long as its handled appropriately.
So yes, I support the death panels.
Except.
Except that sometimes, when you are dealing with a government-funded program, they force the conversation.
The situation was that Mama was involved with a Department of Aging-funded program. I don't know why, but they insisted, required and demanded that we sat down with Mama and have the talk. The Talk.
It was devastating. H didn't want to think of a time where his mother wouldn't be here. He cried, he raged, he avoided. But. But. It came down to losing benefits if we didn't complete the forms.
So we did it. It sucked, it sucked, it sucked and we did it. We talked amongst ourselves, we asked Mama.
And.
And then we knew.
So when it came to that moment, when it came time in the hospital to try 'heroic' measures, when it came to the decision or machine or death, we knew what to do. We knew what Mama wanted us to do.
She didn't want to linger. She didn't want to suffer. She didn't want to be a burden. She didn't want to be in pain.
It still sucked, by the way. And I so did not want to respect her wishes, I wanted to do anything and everything and ANYTHING to keep her around, to keep her in my life. But H stood strong, and did what she wanted.
So.
I can tell you, for a fact, that the conversation would not have happened if the United States Government had not insisted it. And I can tell you, for another fact, that it helped us, as a family, cope with the and come to terms with the severity of Mama's condition.
So, should everyone do it? Should everyone be forced to endure that level of reflection and contemplation?
You're going to have your own opinion, but (within limits) I don't see the downside of it. As long as its handled appropriately.
So yes, I support the death panels.
Lo Siento
A little over a year ago, Mama died.
A little over three months ago, I lost my job.
A little over a month ago, I lost my chance of a second child.
Today, I feel sorry for myself. Please excuse.
Last night my husband and I were talking. Do we pay the maintenance (we have a co-op) or do we pay the mortgage? We don't have the money for both. Both need to be paid to ensure that we have a place to live. But. We don't have the money for both.
I keep hoping that H will find a job but even if he does... it won't be more money. Just better insurance. Insurance that I haven't exhausted the IF coverage on.
But. Let's be realistic. That's not what H does.
I'm lucky to have a child, I know that I am. But. He's never going to know his grandmother.
That pains me.
How can she not be here?
I speak Spanish to Spunx, as I know his Nona would have, but damn my Spanish is crap. And H speaks Spanish with almost no one, now that Mama has passed. So I worry that my promise to Mama, that the children will be raised bi-lingually, will not be kept. That she will be forgotten, that in many small, small ways she will die and die again, until there is nothing left of her.
feeling shorry for myself...
A little over three months ago, I lost my job.
A little over a month ago, I lost my chance of a second child.
Today, I feel sorry for myself. Please excuse.
Last night my husband and I were talking. Do we pay the maintenance (we have a co-op) or do we pay the mortgage? We don't have the money for both. Both need to be paid to ensure that we have a place to live. But. We don't have the money for both.
I keep hoping that H will find a job but even if he does... it won't be more money. Just better insurance. Insurance that I haven't exhausted the IF coverage on.
But. Let's be realistic. That's not what H does.
I'm lucky to have a child, I know that I am. But. He's never going to know his grandmother.
That pains me.
How can she not be here?
I speak Spanish to Spunx, as I know his Nona would have, but damn my Spanish is crap. And H speaks Spanish with almost no one, now that Mama has passed. So I worry that my promise to Mama, that the children will be raised bi-lingually, will not be kept. That she will be forgotten, that in many small, small ways she will die and die again, until there is nothing left of her.
feeling shorry for myself...
Tuesday, September 22, 2009
Sunday, September 20, 2009
Enough Said
My son looks at me with this expression of total joy, total excitement, total wonderment, and I think, why is this not enough?
H has said, exactly, "this is enough" in recent days. And it is. But it isn't.
In other words, I'm fine. I have one son, one husband, one cat and no job. Could be better, could be worse, but right now it's enough. But it isn't.
H has said, exactly, "this is enough" in recent days. And it is. But it isn't.
In other words, I'm fine. I have one son, one husband, one cat and no job. Could be better, could be worse, but right now it's enough. But it isn't.
Saturday, September 5, 2009
Tuesday, September 1, 2009
Once more
It's cold, raining and I'm at the re clinic. What a way to start a weekend. I got here moments before they cut off the morning cattle call, which means I will be here forever. But things could be worse.
Last wanding, I had 4 follies and 2 possibles. That is much MUCH better than the last cycle I had. Clean living and a million vitamin supplements have an effect!
It nay not sound like a lot to you, but last cycle I had 6 follies ( final count) and only one embie. So I'm hopeful.
Thus far, no meltdowns or drama from my cattle sisters. Maybe everyone is having a good day!
Last wanding, I had 4 follies and 2 possibles. That is much MUCH better than the last cycle I had. Clean living and a million vitamin supplements have an effect!
It nay not sound like a lot to you, but last cycle I had 6 follies ( final count) and only one embie. So I'm hopeful.
Thus far, no meltdowns or drama from my cattle sisters. Maybe everyone is having a good day!
Wednesday, August 26, 2009
Cycle
It's here. My cycle
Breathe.
It does not get easier with time, with experience, hell! Even with success. I always know, I cannot shake the fact that this doesn't work more often than it does. (that's a sentence, right?)
I'm at the re's office. Every time I come here, I see someone having a bad day. Last week, it was someone fighting with the cashier about billing ("if you don't pay today we can't proceed with the extraction"). Today, it was some woman being directed to take a prescription ("but I don't understand. Aren't I cycling?"). Tomorrow, it will be someone and something else. I would not love working here.
I am insanely, crazily, obsessively worried about this cycle. I think it's because so much went wrong last cycle, and I know it's the last cycle my insurance allows. No pressure, ovaries, but get pumping.
They switched up my drugs this time. I'm taking f3mara, which is new for me. My clinic is a group practice, and some doctor wrote me a prescription without noting why. When I asked the nurse she shrugged and said "couldn't hurt".
Wish me luck
Breathe.
It does not get easier with time, with experience, hell! Even with success. I always know, I cannot shake the fact that this doesn't work more often than it does. (that's a sentence, right?)
I'm at the re's office. Every time I come here, I see someone having a bad day. Last week, it was someone fighting with the cashier about billing ("if you don't pay today we can't proceed with the extraction"). Today, it was some woman being directed to take a prescription ("but I don't understand. Aren't I cycling?"). Tomorrow, it will be someone and something else. I would not love working here.
I am insanely, crazily, obsessively worried about this cycle. I think it's because so much went wrong last cycle, and I know it's the last cycle my insurance allows. No pressure, ovaries, but get pumping.
They switched up my drugs this time. I'm taking f3mara, which is new for me. My clinic is a group practice, and some doctor wrote me a prescription without noting why. When I asked the nurse she shrugged and said "couldn't hurt".
Wish me luck
Tuesday, August 18, 2009
My Public Service Announcement for Lurkers
Or, What the Heck's an Adzuki Bean, Anyway?
Okay, so I (like many people, I'm sure) bought and read The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies. (It's not a bad book; I recommend it). And I'm sure that many people, like me, read it and found a category they fit into. And the advice is things like "eat organ meat" or "eat dark greens" or, as I mentioned in the subtitle "eat Adzuki beans."
So here is my PSA: if you're following the Infertility Cure, go get a Macrobiotic cookbook. I recommend the "The Hip Chick's Guide to Macrobiotics" but I really recommend looking at any book before you buy it. I'm told that Ayurvedic cooking will also work, but I can't state that as a fact. I will tell you that *my* local bookstore lumped them together and they are not the same thing. (Again, I'm told).
Now, I don't know about you, but I find it hard to find the exotic fixings for macrobiotic recipes. At times, I go to my local Trader Joe's or Whole Paycheck, but for macrobiotic, try your local Japanese, Korean or Chinese market. What is healthy to me is a traditional food there, and the priced usually reflects it. (Hijiki salad? Tofu? Miso Soup? Soooo much cheaper there...) Macrobiotic cooking has its roots in traditional Japanese cooking.
You can find out more (and better) information about macrobiotic cooking elsewhere. Hope you do, and enjoy.
(PS -- added benefits of macrobiotic cooking: You will lose weight, even if you're not trying to).
End of PSA...
Okay, so I (like many people, I'm sure) bought and read The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies. (It's not a bad book; I recommend it). And I'm sure that many people, like me, read it and found a category they fit into. And the advice is things like "eat organ meat" or "eat dark greens" or, as I mentioned in the subtitle "eat Adzuki beans."
So here is my PSA: if you're following the Infertility Cure, go get a Macrobiotic cookbook. I recommend the "The Hip Chick's Guide to Macrobiotics" but I really recommend looking at any book before you buy it. I'm told that Ayurvedic cooking will also work, but I can't state that as a fact. I will tell you that *my* local bookstore lumped them together and they are not the same thing. (Again, I'm told).
Now, I don't know about you, but I find it hard to find the exotic fixings for macrobiotic recipes. At times, I go to my local Trader Joe's or Whole Paycheck, but for macrobiotic, try your local Japanese, Korean or Chinese market. What is healthy to me is a traditional food there, and the priced usually reflects it. (Hijiki salad? Tofu? Miso Soup? Soooo much cheaper there...) Macrobiotic cooking has its roots in traditional Japanese cooking.
You can find out more (and better) information about macrobiotic cooking elsewhere. Hope you do, and enjoy.
(PS -- added benefits of macrobiotic cooking: You will lose weight, even if you're not trying to).
End of PSA...
Monday, August 17, 2009
Ketchup
GET IT? Okay, I'm trying here.
Lessee. When last we spoke, I was thinking of trying a cycle, and trying to scrounge together drugs.
So. Drugs have been scrounged (thanks, all). I'm waiting for AF and ready to go. (eep). Some things I've learned....
Thinking of using IVFMeds.com? Good luck with that. I tried, but my clinic refused to play ball. The clinic refused to explain and IVFMeds had worked with them before, so I am clueless. I'm sure there is a legislative and or insurance-liability-type reason behind it, but DAMN it is annoying. Did you know there's a generic Men0pur?
From there, I went to my insurance carrier. After many (MANY) phone calls, I found someone who recommended the Freedom Pharmacy. While not as cheap as generics from Europe, it was a bit better than over the counter in mid-town Manhattan.
Along the way, I had oral surgery. Which is only relevant because when you have any sort of anesthesia TELL YOUR RE. My clinic FLIPPED OUT. So that's why I'm cycling this month as opposed to last month...
In the mean time, I'm doing accupuncture and taking every vitamin supplement you can think of and eating macrobiotic... Oh, and looking for a job.
Lessee. When last we spoke, I was thinking of trying a cycle, and trying to scrounge together drugs.
So. Drugs have been scrounged (thanks, all). I'm waiting for AF and ready to go. (eep). Some things I've learned....
Thinking of using IVFMeds.com? Good luck with that. I tried, but my clinic refused to play ball. The clinic refused to explain and IVFMeds had worked with them before, so I am clueless. I'm sure there is a legislative and or insurance-liability-type reason behind it, but DAMN it is annoying. Did you know there's a generic Men0pur?
From there, I went to my insurance carrier. After many (MANY) phone calls, I found someone who recommended the Freedom Pharmacy. While not as cheap as generics from Europe, it was a bit better than over the counter in mid-town Manhattan.
Along the way, I had oral surgery. Which is only relevant because when you have any sort of anesthesia TELL YOUR RE. My clinic FLIPPED OUT. So that's why I'm cycling this month as opposed to last month...
In the mean time, I'm doing accupuncture and taking every vitamin supplement you can think of and eating macrobiotic... Oh, and looking for a job.
Wednesday, July 1, 2009
Child mentioned...
As I sit here, trying to get myself together to update my resume together, Spunx is on the floor in front of me. He's got an ancient keyboard that H had squirrled away somewhere. (SHould you ever need antique computer parts, my husband probably has...)
Anyway, Spunx delightedly pounds on the keyboard as though he is typing. He's sitting directly in front of the TV (Y0 Gabba Gabba, should you care). And he is having the best time.
No, Spunx has no computer (unless you count the TV, we're not insane) but he pounds contently, looking up at me every so often and chuckling heartily.
It's a good moment. I thought I'd share.
Wednesday, June 24, 2009
Got drugs?
Irony: having enough coverage for the next IVF procedure, but not for the drugs...
Help! Ideas?
Help! Ideas?
Monday, June 22, 2009
Now what?
I'd been gearing up for my next cycle. Cleaning up my diet, taking my supplements, going to acupuncture and the like.
And then I lose my job.
Now, I have a small severance, and I have COBRA, so I can continue. I gave enough room on my coverage for one more cycle, and I'm approaching the cut-off for the age, so I should go for it.
But my options are (1) that this one is successful, and I'm running around looking for work whilst pregnant or (2) this one isn't successful, and on top of everything else I've got this failure.
I know I have to -- I'm a year and change until I'm uninsureable under NY law. So I have to. But it feels so damn selfish...
I'm sitting here in a St@rbu€k$, contemplating my life and charging my phone. Oh, and spamming my blog as I keep publishing half-baked thoughts.
Hi. How are you?
I don't want to be negative. I don't want to be sad. I want to count my blessings and look on the bright side and find the silver lining and what not.
But I'm a spoilt American girl, and all I can see is what I don't have. (like a job).
Here's what I do have: a husband I like and love, a child I cherish, friends who support me. That can't be undervalued...
Here comes a bumpy ride.
Btw: I'm here waiting until I have a job interview of sorts. Wish me luck...
And then I lose my job.
Now, I have a small severance, and I have COBRA, so I can continue. I gave enough room on my coverage for one more cycle, and I'm approaching the cut-off for the age, so I should go for it.
But my options are (1) that this one is successful, and I'm running around looking for work whilst pregnant or (2) this one isn't successful, and on top of everything else I've got this failure.
I know I have to -- I'm a year and change until I'm uninsureable under NY law. So I have to. But it feels so damn selfish...
I'm sitting here in a St@rbu€k$, contemplating my life and charging my phone. Oh, and spamming my blog as I keep publishing half-baked thoughts.
Hi. How are you?
I don't want to be negative. I don't want to be sad. I want to count my blessings and look on the bright side and find the silver lining and what not.
But I'm a spoilt American girl, and all I can see is what I don't have. (like a job).
Here's what I do have: a husband I like and love, a child I cherish, friends who support me. That can't be undervalued...
Here comes a bumpy ride.
Btw: I'm here waiting until I have a job interview of sorts. Wish me luck...
Next.
I haven't been unemployed in over five years. And then, it was just for a few weeks. Now, I don't have the hope for the job prospects that I once had. So I gave no thoughts as to my future.
Unemployed
I lost my job Tuesday.
How are you doing?
My manager bent over backwards to let me know it wasn't performance related, just the economy.
So now what?
How are you doing?
My manager bent over backwards to let me know it wasn't performance related, just the economy.
So now what?
Monday, June 15, 2009
Mama's picture
I found this picture. It used to be on the website of Mama's daycare. They cropped her out of the picture, which makes graphic (if not emotional) sense.
Saturday, June 6, 2009
God, I'm Boring
See above.
Hi. How are you?
I, currently, am dealing with, well, everything. I still haven't thrown away the photo of my last embie. It lurks in a pocket of my wallet and then everyso often, when I'm digging through looking for something (usually an emergency $20) I find it. My lucky number 7.
And I think, what happened?
On especially horrible days, I find Mama's medicaid card (also hiding in my wallet, in a different location). And, in general, I think, how did this happen?
How is it possible? How? I don't get it. I don't understand. Where did my mother-in-law go? She was here a minute ago. Filling our lives to oveflowing with misery and laughter in equal portion. It's so damn quiet without her. how can she not be here?
Yeah. SO.
I'm boring. Booooooooooooooooring. And decidely not funny.
And I miss my Mama.
Hi. How are you?
I, currently, am dealing with, well, everything. I still haven't thrown away the photo of my last embie. It lurks in a pocket of my wallet and then everyso often, when I'm digging through looking for something (usually an emergency $20) I find it. My lucky number 7.
And I think, what happened?
On especially horrible days, I find Mama's medicaid card (also hiding in my wallet, in a different location). And, in general, I think, how did this happen?
How is it possible? How? I don't get it. I don't understand. Where did my mother-in-law go? She was here a minute ago. Filling our lives to oveflowing with misery and laughter in equal portion. It's so damn quiet without her. how can she not be here?
Yeah. SO.
I'm boring. Booooooooooooooooring. And decidely not funny.
And I miss my Mama.
Saturday, May 16, 2009
So.
I had my annual mammogram the day that I had to go to IF clinic and formally be informed that my latest cycle was a big fat failure.
But. Blame it on the Year of IUIs, I was okay with the BFN. Not okay, but... what's the word for when you get to that mental/emotional/spiritual place where you're so used to failure that hope feels weird and vaguely painful?
That. I didn't feel okay, but comfortable with my familiar misery.
And then I had my mammogram.
And I completely lost it.
I sobbed, uncontrollably, in the hallway before I walked in. I was unable to speak to the receptionist when I finally walked in. I was unable to speak, period. Luckily (?) the office had the impersonal mode of operation -- sign in here, fill out this there, sit down wherever and wait silently while they get to you. I sat in a corner, as far away from everyone as I could be. And I sniffled and I struggled to get myself together and avoided eye contact with anyone and everyone.
Now you might think I was crying because I got my BFN. You may think that I was crying because I had to check off the box stating that I was not pregnant. You might think that, but you'd be wrong.
I was crying because I was thinking of Mama. I was missing Mama. Who died of breast cancer.
Could you just get a mammogram already? Please? Pretty please?
I flunked the mammogram (I always do) and the sonogram was a giggle, as always. I have 16 cysts in my breasts. (The technician was impressed; how about you?) Four of them are "worthy of being monitored" and I have to go back in 6 months.
Please? Get the mammogram, okay?
But. Blame it on the Year of IUIs, I was okay with the BFN. Not okay, but... what's the word for when you get to that mental/emotional/spiritual place where you're so used to failure that hope feels weird and vaguely painful?
That. I didn't feel okay, but comfortable with my familiar misery.
And then I had my mammogram.
And I completely lost it.
I sobbed, uncontrollably, in the hallway before I walked in. I was unable to speak to the receptionist when I finally walked in. I was unable to speak, period. Luckily (?) the office had the impersonal mode of operation -- sign in here, fill out this there, sit down wherever and wait silently while they get to you. I sat in a corner, as far away from everyone as I could be. And I sniffled and I struggled to get myself together and avoided eye contact with anyone and everyone.
Now you might think I was crying because I got my BFN. You may think that I was crying because I had to check off the box stating that I was not pregnant. You might think that, but you'd be wrong.
I was crying because I was thinking of Mama. I was missing Mama. Who died of breast cancer.
Could you just get a mammogram already? Please? Pretty please?
I flunked the mammogram (I always do) and the sonogram was a giggle, as always. I have 16 cysts in my breasts. (The technician was impressed; how about you?) Four of them are "worthy of being monitored" and I have to go back in 6 months.
Please? Get the mammogram, okay?
Friday, April 24, 2009
Blech
I'm here at the clinic so they can make it official.
I currently hate everyone.
No offense. Nothing personal. Sometime later I hope to return to the human race. Sometime later I will start banking karma. Sometime later I will spring into action.
Just not right now. 'Kay?
(to be clear--I'm not being mean or anything to anyone. I just... hurt).
I currently hate everyone.
No offense. Nothing personal. Sometime later I hope to return to the human race. Sometime later I will start banking karma. Sometime later I will spring into action.
Just not right now. 'Kay?
(to be clear--I'm not being mean or anything to anyone. I just... hurt).
Tuesday, April 21, 2009
Monday, April 20, 2009
Sunday, April 19, 2009
Prenatal Testing of Thyroid Is Debated (NYTimes)
By INGFEI CHEN
When women think about pregnancy, the thyroid gland is seldom the first thing that leaps to mind. Nestled in the neck, the gland makes hormones that govern metabolism, helping to regulate body weight, heart rate and a host of other factors.
But if the thyroid malfunctions, it can produce too little or too much of these hormones. During pregnancy those conditions, known as hypothyroidism and hyperthyroidism, respectively, may lead to miscarriage, premature birth and pre-eclampsia — and in the case of hypothyroidism, impaired intelligence in the child.
A decade and a half of research has now brought the cumulative evidence of these risks to a critical mass. Clinical guidelines call for vigilant monitoring and treatment of patients to keep thyroid reserves normal and to safely guide women through pregnancy and early motherhood.
But because thyroid problems can easily go undiagnosed, the hazards have also set off a debate over whether every woman who is pregnant or planning to be should have a blood test to check her thyroid. That test measures for thyroid-stimulating hormone, or T.S.H., which spurs the gland’s hormone production.
Most doctors’ groups have not endorsed universal prenatal thyroid screening, citing uncertainties over whether it would yield health benefits justifying the expense of testing in roughly 6.4 million pregnancies each year and educating doctors to read results that are tricky to interpret.
But the big unanswered question — and crux of the debate — is whether treatment would help women with a mild, common form of thyroid deficiency, called subclinical hypothyroidism. For now, medical societies advise testing only high-risk women.
As a matter of policy, Dr. Kenneth D. Burman, the president of the American Thyroid Association, agrees with that stance for now. Yet like more and more endocrinologists, he offers T.S.H. pregnancy testing in his practice, at Washington Hospital Center in Washington.
“Every patient I see who’s considering getting pregnant or is pregnant gets a thyroid function test,” he said. “And I think that’s the right thing to do.”
He and others say they expect more and more doctors and medical societies to support universal screening after weighing all the evidence. The thyroid association is holding a symposium this Thursday and Friday in Washington to discuss the most recent research.
Symptoms of a wayward thyroid can be subtle, and pregnancy can mask them. Fatigue, weight gain and dry skin — all typical in pregnant women — can also result from hypothyroidism, said Dr. Alex Stagnaro-Green, an endocrinologist at Touro University College of Medicine in Hackensack, N.J.
The opposite condition, hyperthyroidism, affects roughly 2 in 1,000 pregnancies. But again, its symptoms — poor sleep, weight loss and nervousness after childbirth — could result from other postpartum conditions. (Renaissance painters unknowingly depicted the link between thyroid problems and pregnancy by showing women with goiters from an overactive thryoid after childbirth.)
Hypothyroidism, which usually arises from underlying autoimmune disease, is the more frequent and worrisome concern. As many as 10 to 20 percent of reproductive-age women test positive for antibodies that attack the thyroid gland and may eventually destroy it. Their risk of miscarriage is doubled.
Three to five out of 1,000 women of childbearing age suffer from overt hypothyroidism, in which thyroid hormone, or T4, is low and T.S.H. is abnormally high. But the most common thyroid dysfunction is subclinical hypothyroidism, in which T4 is normal but T.S.H. is slightly elevated. That condition affects 2 to 3 percent of women but often goes undiagnosed when it causes no obvious symptoms.
Hypothyroidism may harm fetal brain development. Ten years ago, researchers in Maine analyzed blood samples from 25,216 pregnant women and identified 62 with hypothyroidism. Their children, by then 7 to 9 years old, were given intelligence tests. Nineteen percent of the children born to women with an untreated underactive thyroid had an I.Q. of 85 or lower, compared with 5 percent of those whose mothers had a healthy thyroid. “At about 85 or below, that’s where you begin to have trouble in school and in life in general,” said Dr. James E. Haddow, a pediatrician at Brown University who was an author of the study. But if mothers had their hypothyroidism treated, their children’s intelligence was not impaired.
In reaction, the American Association of Clinical Endocrinologists endorsed routine T.S.H. testing in all women considering pregnancy. But other organizations, including the American College of Obstetricians and Gynecologists, have said wide-scale screening is premature until more data prove that treating subclinical hypothyroidism would prevent adverse effects in women and their offspring.
Studies do suggest that T4-replacement therapy is protective. But few large clinical trials have rigorously tested this intervention in mildly thyroid-deficient women. So far, promising results have come from one major, well-designed Italian study that showed miscarriage and preterm delivery rates dropped sharply when thyroid hormone pills were given to pregnant women who tested positive for thyroid antibodies.
Experts are now looking to the outcomes of two other major clinical trials under way in Wales and the United States. Both aim to confirm the I.Q. effects and the ability to avert them by studying pregnant women with underactive thyroids who receive hormone therapy or no treatment.
Pregnancy is such a critical time that “to expose a baby to a medication without known benefit may not be the best thing, unless we truly know that it’s helpful,” said Dr. Catherine Spong, the chief of pregnancy and perinatology at the National Institute of Child Health and Human Development, which is sponsoring the American trial.
That study will track 1,170 expecting mothers, including women with subclinical hypothyroidism, and their children will undergo I.Q. testing at age 5. Results are expected in 2015.
Advocates of routine testing see no need to wait for more answers, though. Dr. Terry F. Davies, an endocrinologist at the Mount Sinai School of Medicine in New York, finds the evidence “overwhelming” that a shortage of maternal thyroid hormone harms intellectual function in babies. “Once you believe that,” he said, “it would seem to me illogical not to be sure that all women have normal thyroid function during pregnancy.”
And Dr. Haddow said universal prenatal testing could be justified on the grounds of benefiting a woman’s general health. In the Maine study, 58 percent of the pregnant women who had hypothyroidism but did not know it eventually did have it diagnosed, but it took an average of five years. Pregnancy is “an optimal time” for T.S.H. testing, he said.
Most medical societies endorse only selective screening. Two years ago, the Endocrine Society released recommendations for testing T.S.H. in women at high risk for thyroid disorders, including anyone with symptoms of a goiter or sluggish thyroid, or a family history of thyroid problems, as well as those with Type 1 diabetes or autoimmune disease or previous miscarriage or premature delivery.
But research since then has revealed flaws in that strategy. “The problem is, it’s not good enough,” Dr. Stagnaro-Green said. A British study found that such testing missed 30 percent of those with hypothyroidism and 69 percent of those with hyperthyroidism.
For now, until there is confirmation that treatment truly helps, Dr. Stagnaro-Green said he still favored selective thyroid screening. But he added, “My belief is that data will be forthcoming that will push us towards universal screening.”
When women think about pregnancy, the thyroid gland is seldom the first thing that leaps to mind. Nestled in the neck, the gland makes hormones that govern metabolism, helping to regulate body weight, heart rate and a host of other factors.
But if the thyroid malfunctions, it can produce too little or too much of these hormones. During pregnancy those conditions, known as hypothyroidism and hyperthyroidism, respectively, may lead to miscarriage, premature birth and pre-eclampsia — and in the case of hypothyroidism, impaired intelligence in the child.
A decade and a half of research has now brought the cumulative evidence of these risks to a critical mass. Clinical guidelines call for vigilant monitoring and treatment of patients to keep thyroid reserves normal and to safely guide women through pregnancy and early motherhood.
But because thyroid problems can easily go undiagnosed, the hazards have also set off a debate over whether every woman who is pregnant or planning to be should have a blood test to check her thyroid. That test measures for thyroid-stimulating hormone, or T.S.H., which spurs the gland’s hormone production.
Most doctors’ groups have not endorsed universal prenatal thyroid screening, citing uncertainties over whether it would yield health benefits justifying the expense of testing in roughly 6.4 million pregnancies each year and educating doctors to read results that are tricky to interpret.
But the big unanswered question — and crux of the debate — is whether treatment would help women with a mild, common form of thyroid deficiency, called subclinical hypothyroidism. For now, medical societies advise testing only high-risk women.
As a matter of policy, Dr. Kenneth D. Burman, the president of the American Thyroid Association, agrees with that stance for now. Yet like more and more endocrinologists, he offers T.S.H. pregnancy testing in his practice, at Washington Hospital Center in Washington.
“Every patient I see who’s considering getting pregnant or is pregnant gets a thyroid function test,” he said. “And I think that’s the right thing to do.”
He and others say they expect more and more doctors and medical societies to support universal screening after weighing all the evidence. The thyroid association is holding a symposium this Thursday and Friday in Washington to discuss the most recent research.
Symptoms of a wayward thyroid can be subtle, and pregnancy can mask them. Fatigue, weight gain and dry skin — all typical in pregnant women — can also result from hypothyroidism, said Dr. Alex Stagnaro-Green, an endocrinologist at Touro University College of Medicine in Hackensack, N.J.
The opposite condition, hyperthyroidism, affects roughly 2 in 1,000 pregnancies. But again, its symptoms — poor sleep, weight loss and nervousness after childbirth — could result from other postpartum conditions. (Renaissance painters unknowingly depicted the link between thyroid problems and pregnancy by showing women with goiters from an overactive thryoid after childbirth.)
Hypothyroidism, which usually arises from underlying autoimmune disease, is the more frequent and worrisome concern. As many as 10 to 20 percent of reproductive-age women test positive for antibodies that attack the thyroid gland and may eventually destroy it. Their risk of miscarriage is doubled.
Three to five out of 1,000 women of childbearing age suffer from overt hypothyroidism, in which thyroid hormone, or T4, is low and T.S.H. is abnormally high. But the most common thyroid dysfunction is subclinical hypothyroidism, in which T4 is normal but T.S.H. is slightly elevated. That condition affects 2 to 3 percent of women but often goes undiagnosed when it causes no obvious symptoms.
Hypothyroidism may harm fetal brain development. Ten years ago, researchers in Maine analyzed blood samples from 25,216 pregnant women and identified 62 with hypothyroidism. Their children, by then 7 to 9 years old, were given intelligence tests. Nineteen percent of the children born to women with an untreated underactive thyroid had an I.Q. of 85 or lower, compared with 5 percent of those whose mothers had a healthy thyroid. “At about 85 or below, that’s where you begin to have trouble in school and in life in general,” said Dr. James E. Haddow, a pediatrician at Brown University who was an author of the study. But if mothers had their hypothyroidism treated, their children’s intelligence was not impaired.
In reaction, the American Association of Clinical Endocrinologists endorsed routine T.S.H. testing in all women considering pregnancy. But other organizations, including the American College of Obstetricians and Gynecologists, have said wide-scale screening is premature until more data prove that treating subclinical hypothyroidism would prevent adverse effects in women and their offspring.
Studies do suggest that T4-replacement therapy is protective. But few large clinical trials have rigorously tested this intervention in mildly thyroid-deficient women. So far, promising results have come from one major, well-designed Italian study that showed miscarriage and preterm delivery rates dropped sharply when thyroid hormone pills were given to pregnant women who tested positive for thyroid antibodies.
Experts are now looking to the outcomes of two other major clinical trials under way in Wales and the United States. Both aim to confirm the I.Q. effects and the ability to avert them by studying pregnant women with underactive thyroids who receive hormone therapy or no treatment.
Pregnancy is such a critical time that “to expose a baby to a medication without known benefit may not be the best thing, unless we truly know that it’s helpful,” said Dr. Catherine Spong, the chief of pregnancy and perinatology at the National Institute of Child Health and Human Development, which is sponsoring the American trial.
That study will track 1,170 expecting mothers, including women with subclinical hypothyroidism, and their children will undergo I.Q. testing at age 5. Results are expected in 2015.
Advocates of routine testing see no need to wait for more answers, though. Dr. Terry F. Davies, an endocrinologist at the Mount Sinai School of Medicine in New York, finds the evidence “overwhelming” that a shortage of maternal thyroid hormone harms intellectual function in babies. “Once you believe that,” he said, “it would seem to me illogical not to be sure that all women have normal thyroid function during pregnancy.”
And Dr. Haddow said universal prenatal testing could be justified on the grounds of benefiting a woman’s general health. In the Maine study, 58 percent of the pregnant women who had hypothyroidism but did not know it eventually did have it diagnosed, but it took an average of five years. Pregnancy is “an optimal time” for T.S.H. testing, he said.
Most medical societies endorse only selective screening. Two years ago, the Endocrine Society released recommendations for testing T.S.H. in women at high risk for thyroid disorders, including anyone with symptoms of a goiter or sluggish thyroid, or a family history of thyroid problems, as well as those with Type 1 diabetes or autoimmune disease or previous miscarriage or premature delivery.
But research since then has revealed flaws in that strategy. “The problem is, it’s not good enough,” Dr. Stagnaro-Green said. A British study found that such testing missed 30 percent of those with hypothyroidism and 69 percent of those with hyperthyroidism.
For now, until there is confirmation that treatment truly helps, Dr. Stagnaro-Green said he still favored selective thyroid screening. But he added, “My belief is that data will be forthcoming that will push us towards universal screening.”
Saturday, April 18, 2009
Is it Friday yet?
I have nothing to report.
I pray. I plead. I try to remain positive.
And this has only been a week. (Not even).
I haven't had any possibility of going to acupuncture or anything like it.
After the transfer, I came home and vowed to stay in bed all day. But Spunx and babysitter had different plans. So many questions and interruptions. Finally, I came out and played with my child (and sent the sitter home).
Last time, I sat down with funny DVDs and laughed myself silly. This time, I could find nothing funny and even the funny stuff made me cry.
But.
But I played with my baby (who's now more of a toddler) and I smiled.
And I'm hoping.
I have the same ache on my left side that I did last time. Which means nothing, I know. And yesterday, I had breast tenderness. (Not that I have any today). Which means nothing, I know.
Maybe I'm asking too much. Maybe I'm greedy. Maybe I don't deserve any more.
I pray. I plead. I try to remain positive.
And this has only been a week. (Not even).
I haven't had any possibility of going to acupuncture or anything like it.
After the transfer, I came home and vowed to stay in bed all day. But Spunx and babysitter had different plans. So many questions and interruptions. Finally, I came out and played with my child (and sent the sitter home).
Last time, I sat down with funny DVDs and laughed myself silly. This time, I could find nothing funny and even the funny stuff made me cry.
But.
But I played with my baby (who's now more of a toddler) and I smiled.
And I'm hoping.
I have the same ache on my left side that I did last time. Which means nothing, I know. And yesterday, I had breast tenderness. (Not that I have any today). Which means nothing, I know.
Maybe I'm asking too much. Maybe I'm greedy. Maybe I don't deserve any more.
Tuesday, April 14, 2009
Lucky number 7 (cells)
Yesterday, we transferred one lonely embie.
She was, indeed, primo stuff. She was an graded FBB (F is for "Fair" and the "B" is on a A-B-C-D scale).
She had seven cells.
I've never had an embryo with seven cells before. Last transfer, I had 2 six-cells, a five-cell and some that were less than that. And them time before that, I only reached six-cells, as well.
But seven?
Wow.
She was, indeed, primo stuff. She was an graded FBB (F is for "Fair" and the "B" is on a A-B-C-D scale).
She had seven cells.
I've never had an embryo with seven cells before. Last transfer, I had 2 six-cells, a five-cell and some that were less than that. And them time before that, I only reached six-cells, as well.
But seven?
Wow.
Monday, April 13, 2009
Sunday, April 12, 2009
Evidence That Mice Produce Egg Cells After Birth
From the NY Times
By NICHOLAS WADE
Scientists in Shanghai have challenged the orthodox medical view that a woman is born with egg cells to last a lifetime and will never generate any new ones. Overthrow of this view could hold major implications for treatment of infertility.
Similar challenges have been made before, but none have been sustained. Earlier this month, however, the same medical doctrine with respect to heart muscle cells — that you die with the same cells you are born with — was shown by a Swedish scientist, Jonas Frisen, to be incorrect: the muscle cells do get replaced, though very slowly, at the rate of 1 percent or less per year.
The Chinese team, led by Kang Zou and Ji Wu of Shanghai Jiao Tong University, worked only with mice, but because of the similarity of all mammalian physiology, any proof that mice could produce eggs after birth would set off a race to prove that people could too.
In essence, the Shanghai researchers say they have detected, in both young and old mice, the germ-line cells that produce unfertilized eggs, or oocytes.
The researchers report in the current issue of Nature Cell Biology that they scanned a mouse’s ovaries for cells producing a protein called vasa homolog that is found only in the germ-line cells. During the embryo’s formation, these cells generate all the oocytes that will be needed over the female’s lifetime.
The researchers detected vasa-producing cells in the mouse ovaries, fished them out and grew them in laboratory glassware. There the cells were injected with a gene that makes green fluorescent protein, a standard way of marking cells.
The researchers then injected the germ-line cells into the ovaries of another batch of mice whose own eggs had been killed. When the mice were mated, some of their offspring were green, indicating that they originated from eggs produced by the injected germ-line cells.
David F. Albertini, an expert on reproduction at the University of Kansas Medical Center, said the result was “a pretty exciting observation” but added that the experiment was difficult to interpret. He said that perhaps the authors had fished out a few oocytes, despite their efforts to exclude them, along with the germ-line cells, and that these oocytes could have been the origin of the infant mice produced later.
Until this and other issues have been sorted out, the observation is “not relevant clinically,” Dr. Albertini said, given the physiological differences between mice and people.
Dr. Albertini also said that in publishing the Shanghai paper and earlier claims of oocytes being produced after birth, Nature had neglected to seek the advice of a network of ovarian experts, including himself.
Dr. Frisen, the Swedish researcher who proved that heart muscle cells were generated throughout life, said he had not yet been able to apply his method to oocytes. His approach is to measure radioactive carbon-14, which was generated by aboveground nuclear tests in the 1960s and for years could be found in the DNA of cells throughout the world. The amount of carbon-14 in each cell type indicates its birth date.
Dr. Frisen said that there were not enough oocytes in a person’s body to give a reliable signal at present but added that he hoped to study oocytes’ birth date when he had improved the sensitivity of his technique.
By NICHOLAS WADE
Scientists in Shanghai have challenged the orthodox medical view that a woman is born with egg cells to last a lifetime and will never generate any new ones. Overthrow of this view could hold major implications for treatment of infertility.
Similar challenges have been made before, but none have been sustained. Earlier this month, however, the same medical doctrine with respect to heart muscle cells — that you die with the same cells you are born with — was shown by a Swedish scientist, Jonas Frisen, to be incorrect: the muscle cells do get replaced, though very slowly, at the rate of 1 percent or less per year.
The Chinese team, led by Kang Zou and Ji Wu of Shanghai Jiao Tong University, worked only with mice, but because of the similarity of all mammalian physiology, any proof that mice could produce eggs after birth would set off a race to prove that people could too.
In essence, the Shanghai researchers say they have detected, in both young and old mice, the germ-line cells that produce unfertilized eggs, or oocytes.
The researchers report in the current issue of Nature Cell Biology that they scanned a mouse’s ovaries for cells producing a protein called vasa homolog that is found only in the germ-line cells. During the embryo’s formation, these cells generate all the oocytes that will be needed over the female’s lifetime.
The researchers detected vasa-producing cells in the mouse ovaries, fished them out and grew them in laboratory glassware. There the cells were injected with a gene that makes green fluorescent protein, a standard way of marking cells.
The researchers then injected the germ-line cells into the ovaries of another batch of mice whose own eggs had been killed. When the mice were mated, some of their offspring were green, indicating that they originated from eggs produced by the injected germ-line cells.
David F. Albertini, an expert on reproduction at the University of Kansas Medical Center, said the result was “a pretty exciting observation” but added that the experiment was difficult to interpret. He said that perhaps the authors had fished out a few oocytes, despite their efforts to exclude them, along with the germ-line cells, and that these oocytes could have been the origin of the infant mice produced later.
Until this and other issues have been sorted out, the observation is “not relevant clinically,” Dr. Albertini said, given the physiological differences between mice and people.
Dr. Albertini also said that in publishing the Shanghai paper and earlier claims of oocytes being produced after birth, Nature had neglected to seek the advice of a network of ovarian experts, including himself.
Dr. Frisen, the Swedish researcher who proved that heart muscle cells were generated throughout life, said he had not yet been able to apply his method to oocytes. His approach is to measure radioactive carbon-14, which was generated by aboveground nuclear tests in the 1960s and for years could be found in the DNA of cells throughout the world. The amount of carbon-14 in each cell type indicates its birth date.
Dr. Frisen said that there were not enough oocytes in a person’s body to give a reliable signal at present but added that he hoped to study oocytes’ birth date when he had improved the sensitivity of his technique.
I remembered something...
This morning (or was it last night?) I remembered the prayer I used to say the last time I was trying to get pregnant.
"I surrender myself into your hands, oh Lord..."
I never finished the line, although I always felt unfinished. The only thing that came to my mind past that was along the lines of "'cuz dammit you're in charge anyway" or "'cuz there's not a lot else I can do, is there?" neither of which strikes the pious tone that I'm looking for.
But.
Odd that I forgot that (I used to say that every day, I don't know how many times a day, occasionally with some non-pious additions). Odd that I remembered that now.
I surrender...
H is very depressed about the one embryo situation. Which triggers the lingering depression about Mama. And then that just sets off dominos of other contemplation.
I surrender...
He asked me this morning, what did I want to do. And I answered. I want to get pregnant. I want to have twins. (Yes, I know the additional risks of twins, but still). I want to have twin girls. I have names already picked out for twin girls (which I know that you're never supposed to do, but this is my dream so I'm dreaming big and in detail).
H laughed at the thought of it. Twin girls beating up on poor Spunx. Trailing him around, bothering him, "ganging up on him," to quote my husband. It made us feel a bit better.
I surrender...
I did explain to my husband that there is very little chance that we'd get twins at this point. Which sobered him, and then we talked about doing another cycle. If we needed to. Current insurance covers about a cycle and a half, so if we needed to, well. We could.
I surrender...
We figure that we'd (which is to say *I*) would take a cycle off, eat healthy, be health, figure out a way to get to my acupuncturist, take all my supplements and all that. Acutally take our shots on time. All that.
And then go back. For one last try.
If we need to. (Not that I want to).
I surrender.
"I surrender myself into your hands, oh Lord..."
I never finished the line, although I always felt unfinished. The only thing that came to my mind past that was along the lines of "'cuz dammit you're in charge anyway" or "'cuz there's not a lot else I can do, is there?" neither of which strikes the pious tone that I'm looking for.
But.
Odd that I forgot that (I used to say that every day, I don't know how many times a day, occasionally with some non-pious additions). Odd that I remembered that now.
I surrender...
H is very depressed about the one embryo situation. Which triggers the lingering depression about Mama. And then that just sets off dominos of other contemplation.
I surrender...
He asked me this morning, what did I want to do. And I answered. I want to get pregnant. I want to have twins. (Yes, I know the additional risks of twins, but still). I want to have twin girls. I have names already picked out for twin girls (which I know that you're never supposed to do, but this is my dream so I'm dreaming big and in detail).
H laughed at the thought of it. Twin girls beating up on poor Spunx. Trailing him around, bothering him, "ganging up on him," to quote my husband. It made us feel a bit better.
I surrender...
I did explain to my husband that there is very little chance that we'd get twins at this point. Which sobered him, and then we talked about doing another cycle. If we needed to. Current insurance covers about a cycle and a half, so if we needed to, well. We could.
I surrender...
We figure that we'd (which is to say *I*) would take a cycle off, eat healthy, be health, figure out a way to get to my acupuncturist, take all my supplements and all that. Acutally take our shots on time. All that.
And then go back. For one last try.
If we need to. (Not that I want to).
I surrender.
Saturday, April 11, 2009
One Good Egg
Yep. One lil embie to transfer on Monday.
My husband said the doctor said it was, and I quote, primo stuff. H swore it was an exact quote from the doctor.
Huh.
We'll see.
My husband said the doctor said it was, and I quote, primo stuff. H swore it was an exact quote from the doctor.
Huh.
We'll see.
Math does not equal hope
Since going through Mama's death, H has been even more adamant that we have another child. For Spunx. So when I die, when H dies, Spunk is not alone. Spunx has someone to lean on, to share with, to fight with. Someone to share witness. And so there is someone else who knows all Spunx secrets, whatever they may grow to be.
In a perfect world, we'd probably be taking more time. But in this world, health insurance will only cover me after I'm 44. And I'm 42. So I didn't have the luxury of contemplation and whatnot. If we wanted to do this, I need to do it now.
Periodically, H and I will look at each other, and one of us will say "We're not being greedy." Which is a lie. We are. We are being greedy. We want more. Maybe just one more, but more. Greedy for the a good reason, but greedy nonetheless. H and I were only children (there's a decade in age difference between myself and my brother). We didn't have that constant companion and playmate. We didn't have that support.
I blogged yesterday from the RE's office, but it didn't seem to take. Whoops. Yesterday was the retrieval.
The retrieval... was a retrieval. Yesterday. Six eggs they got. Compared to the 14 that they got from my last cycle. The doctor came shortly after the procedure to tell me. She put her hand on my knee and then said, "and not all of them are mature." And then said something that I don't quite recall, but it was to the tune of "we'll see."
This did not happen last cycle.
So last cycle they got 14 eggs, 11 were mature, 5 fertilized, 3 got to six-celled stages and resulted in 2 pregnancies and one child. So, applying the same math, out of 6 eggs, 4.7 will be mature, 2.5 will fertilize and 1.2 will get to the 6-cell stage. The numbers from there are below 1.
Math sucks.
I'm not quite sure what to feel right now. What to hope for. How to pray.
In a perfect world, we'd probably be taking more time. But in this world, health insurance will only cover me after I'm 44. And I'm 42. So I didn't have the luxury of contemplation and whatnot. If we wanted to do this, I need to do it now.
Periodically, H and I will look at each other, and one of us will say "We're not being greedy." Which is a lie. We are. We are being greedy. We want more. Maybe just one more, but more. Greedy for the a good reason, but greedy nonetheless. H and I were only children (there's a decade in age difference between myself and my brother). We didn't have that constant companion and playmate. We didn't have that support.
I blogged yesterday from the RE's office, but it didn't seem to take. Whoops. Yesterday was the retrieval.
The retrieval... was a retrieval. Yesterday. Six eggs they got. Compared to the 14 that they got from my last cycle. The doctor came shortly after the procedure to tell me. She put her hand on my knee and then said, "and not all of them are mature." And then said something that I don't quite recall, but it was to the tune of "we'll see."
This did not happen last cycle.
So last cycle they got 14 eggs, 11 were mature, 5 fertilized, 3 got to six-celled stages and resulted in 2 pregnancies and one child. So, applying the same math, out of 6 eggs, 4.7 will be mature, 2.5 will fertilize and 1.2 will get to the 6-cell stage. The numbers from there are below 1.
Math sucks.
I'm not quite sure what to feel right now. What to hope for. How to pray.
Friday, April 10, 2009
Just called
H just called, to say that he's on his way. That's good, as he's 30 minutes late. The clinic folk are freaking, but I'm fairly calm. Fairly.
It's my retrieval morning, did I mention?
They had wanted H in much, much earlier than I, but I'm the ticking time bomb of love. He just needs to masturbate. (Hee hee. "Just"). The clinic has had problems with, ahem, stage fright, so a late husband worries them.
Forms to fill out. TTFN
It's my retrieval morning, did I mention?
They had wanted H in much, much earlier than I, but I'm the ticking time bomb of love. He just needs to masturbate. (Hee hee. "Just"). The clinic has had problems with, ahem, stage fright, so a late husband worries them.
Forms to fill out. TTFN
Tuesday, April 7, 2009
Monday, April 6, 2009
Cheese with the Whine
"You're not doing as well as last time" says the RE. Not that I did so well last time. Not that I'm going so poorly that they'd cancel it.
But.
But.
I should, ahem, adjust my expectations.
And, oh yeah. They're missing paperwork from my GYN. Which they need before they retrieve on Friday.
FRIDAY.
This cycle has jetted past...
But.
But.
I should, ahem, adjust my expectations.
And, oh yeah. They're missing paperwork from my GYN. Which they need before they retrieve on Friday.
FRIDAY.
This cycle has jetted past...
Sunday, April 5, 2009
Everything That Can Go Wrong...
I remember my last cycle as smooth.
I've been re-reading my old blog, and it seems it was smooth. My meds showed up, I went to my (then) new clinic, I kept freaking out and telling everyone that I was "different" and "difficult" and "special." And they nodded and said "uh huh" and told me I was just like everybody else.
Last cycle, H and I went to the I.V.F. class where he showed his A-type personality. Last cycle, he had every dose perfectly prepared on a freshly scrubbed kitchen counter that he injected at exactly 24-hour intervals.
And while I had complications, I now have a baby. SO for the most part... Smooth.
Then... there's this cycle.
Not smooth.
On CD2, I went to the wrong floor of my clinic. (Yes, my clinic is SO HUGE they separate out the IUIs from the IVFs). So I had to wait twice as long for my blood and wand combo.
Nice.
At the end, I was late for work, so when they said "go talk to a nurse about your meds," I said, "H will have to do it. I'm late, and he's giving the shot anyway." And ran out the door.
Now, H was home that day sick. But I'd asked him to (a) call the clinic and get the info and (b) get the whole enchilada -- what drugs am I taking when, etc. There was a not in my last shipment about a problem with something, and I wasn't sure if it was resolved and I was worried.
H called and got the information for that night. If I make it sound easy, it wasn't. The nurses are only available for six hours a day, and they only have one or two who handle the shots and drugs questions, and they kept calling me back (not him, as they've been instructed millions of times). And when they did call H back, they got his voicemail because H was asleep.
So, 6 phone calls and 5 hours later, H got the information for that night.
The first night, H pulls out the needle before it's done releasing medicine. There's not enough left in it (and I am not brave enough) to warrant injecting me again. But DAMN. It's not off to an auspicious start.
The second day, I realize I don't know when I am to go back. No one told me. Quite by accident, I read an old post of mine that states my clinic does day 2, then day 7. Except that last cycle, I went on day 4 (or was it 5?). Because I'm "special." So what am I going to do?
Again with the Nurse phone tag. One message, two message, three message, four. Finally, I get a chirpy gal who pulls my chart and says that I'm not supposed to come in tomorrow. She doesn't know when I'm supposed to come in, but it is definitely NOT tomorrow.
So Day 3 dawn with more message Olympics. This time I hang tough, spend 20 minutes (no exaggeration) on hold and speak to a human. I spend another 15 minutes on hold while she consults with whomever and whatever and tells me that I'm to come in Saturday.
Okay. Great.
That night, H and I are tired. Ridiculously tired. We fall asleep in each others arms (awwwwwwww) without my being shot (WHOOPS!).
We're awakened my Spunketta at 3:00AM, and after lulling my lil miracle back to sleep, I sit up and scream in terror (or as close as you can while whispering) WE FORGOT MY DRUGS!
H decides that the thing to do is to do the shot ASAP. We run to the kitchen and H prepares them. He drops a vial (or two) but finally, all is prepped and the belly is shot. I'm freaking out and panicking (my specialty) and H is calming. It'll be fine, he says. Just you watch.
So the next day, I'm back to calling the clinic. It is fine, the nurse assures me. You shouldn't really take so long, but I'm sure it will be okay.
Okay, fine. Breathe, I tell myself. Maybe they'll just up the dosage later on, or such. Maybe.
Okay, so where are we now? Day 6?
This cycle, H has not nearly been as smooth as with the first. He's scrambling, disorganized. It makes me nervous, honestly. He was exactingly precise the last time; I always secretly credit that precision with the cycle working.
Day 6, H prepares the drugs and shoots me. (We now say to each other throughout the day REMEMBER THE DRUGS the way other couples may say "I love you.") As he's tidying up the area, he starts swearing mightily.
"What's wrong?"
"I forgot to mix in one of the g0nal F vials!"
This is big doings; even I know it. He digs around and puts together another syringe and I get shot again.
The next day is Day 7. I get up at Dark-thirty and head to the clinic. On the right floor. I wait 45 minutes (as you do) and I get blooded. And I see my doctor.
The second shot was completely correct, the doctor assures me. And the late shot was fine, she continues me. It's not like it's it was the Ganire1ix, she chuckles. Don't forget that.
My drugs changed on CD7, and this time stuck around with the nurse to have it explained. "Now you take Ganire1ix," she explained. The nurse was very solemn. "You CANNOT be late. You HAVE to take the Ganire1ix at the same time EVERY DAY. If you do not, you will ruin this cycle."
No pressure.
From the clinic, I head to work.
I call H to let him know about the changes in drugs. (He's sleeping). I call and and I call and I call and finally rouse him.
"Just check that we have everything we need," I beg. And he does.
He calls me back. "I can't find the Ganire1ix," he states. "Do you have the name right? Are you pronouncing it correctly?" I spell it out to him but don't even try to pronounce it.
"Call the clinic, and have them phone it in to the specialty pharmacy," I command. (I know the names of both fertility pharmacies in NYC). He does and they do.
Then, all he has to do is trek over there with Spunx. And, oh yeah, PAY for it. Except it's a weekend, and we can't get ahold of anyone from the insurance company, and the pharmacy doesn't take the our new health insurance. So H had to pay full price for infertility meds. That took some doing.
So last night, I got my meds (all of them) right on time.
And the television broke.
And a co-worker died.
And I miss Mama.
And I cried so hard I gave myself hiccups.
This is not a smooth cycle.
I've been re-reading my old blog, and it seems it was smooth. My meds showed up, I went to my (then) new clinic, I kept freaking out and telling everyone that I was "different" and "difficult" and "special." And they nodded and said "uh huh" and told me I was just like everybody else.
Last cycle, H and I went to the I.V.F. class where he showed his A-type personality. Last cycle, he had every dose perfectly prepared on a freshly scrubbed kitchen counter that he injected at exactly 24-hour intervals.
And while I had complications, I now have a baby. SO for the most part... Smooth.
Then... there's this cycle.
Not smooth.
On CD2, I went to the wrong floor of my clinic. (Yes, my clinic is SO HUGE they separate out the IUIs from the IVFs). So I had to wait twice as long for my blood and wand combo.
Nice.
At the end, I was late for work, so when they said "go talk to a nurse about your meds," I said, "H will have to do it. I'm late, and he's giving the shot anyway." And ran out the door.
Now, H was home that day sick. But I'd asked him to (a) call the clinic and get the info and (b) get the whole enchilada -- what drugs am I taking when, etc. There was a not in my last shipment about a problem with something, and I wasn't sure if it was resolved and I was worried.
H called and got the information for that night. If I make it sound easy, it wasn't. The nurses are only available for six hours a day, and they only have one or two who handle the shots and drugs questions, and they kept calling me back (not him, as they've been instructed millions of times). And when they did call H back, they got his voicemail because H was asleep.
So, 6 phone calls and 5 hours later, H got the information for that night.
The first night, H pulls out the needle before it's done releasing medicine. There's not enough left in it (and I am not brave enough) to warrant injecting me again. But DAMN. It's not off to an auspicious start.
The second day, I realize I don't know when I am to go back. No one told me. Quite by accident, I read an old post of mine that states my clinic does day 2, then day 7. Except that last cycle, I went on day 4 (or was it 5?). Because I'm "special." So what am I going to do?
Again with the Nurse phone tag. One message, two message, three message, four. Finally, I get a chirpy gal who pulls my chart and says that I'm not supposed to come in tomorrow. She doesn't know when I'm supposed to come in, but it is definitely NOT tomorrow.
So Day 3 dawn with more message Olympics. This time I hang tough, spend 20 minutes (no exaggeration) on hold and speak to a human. I spend another 15 minutes on hold while she consults with whomever and whatever and tells me that I'm to come in Saturday.
Okay. Great.
That night, H and I are tired. Ridiculously tired. We fall asleep in each others arms (awwwwwwww) without my being shot (WHOOPS!).
We're awakened my Spunketta at 3:00AM, and after lulling my lil miracle back to sleep, I sit up and scream in terror (or as close as you can while whispering) WE FORGOT MY DRUGS!
H decides that the thing to do is to do the shot ASAP. We run to the kitchen and H prepares them. He drops a vial (or two) but finally, all is prepped and the belly is shot. I'm freaking out and panicking (my specialty) and H is calming. It'll be fine, he says. Just you watch.
So the next day, I'm back to calling the clinic. It is fine, the nurse assures me. You shouldn't really take so long, but I'm sure it will be okay.
Okay, fine. Breathe, I tell myself. Maybe they'll just up the dosage later on, or such. Maybe.
Okay, so where are we now? Day 6?
This cycle, H has not nearly been as smooth as with the first. He's scrambling, disorganized. It makes me nervous, honestly. He was exactingly precise the last time; I always secretly credit that precision with the cycle working.
Day 6, H prepares the drugs and shoots me. (We now say to each other throughout the day REMEMBER THE DRUGS the way other couples may say "I love you.") As he's tidying up the area, he starts swearing mightily.
"What's wrong?"
"I forgot to mix in one of the g0nal F vials!"
This is big doings; even I know it. He digs around and puts together another syringe and I get shot again.
The next day is Day 7. I get up at Dark-thirty and head to the clinic. On the right floor. I wait 45 minutes (as you do) and I get blooded. And I see my doctor.
The second shot was completely correct, the doctor assures me. And the late shot was fine, she continues me. It's not like it's it was the Ganire1ix, she chuckles. Don't forget that.
My drugs changed on CD7, and this time stuck around with the nurse to have it explained. "Now you take Ganire1ix," she explained. The nurse was very solemn. "You CANNOT be late. You HAVE to take the Ganire1ix at the same time EVERY DAY. If you do not, you will ruin this cycle."
No pressure.
From the clinic, I head to work.
I call H to let him know about the changes in drugs. (He's sleeping). I call and and I call and I call and finally rouse him.
"Just check that we have everything we need," I beg. And he does.
He calls me back. "I can't find the Ganire1ix," he states. "Do you have the name right? Are you pronouncing it correctly?" I spell it out to him but don't even try to pronounce it.
"Call the clinic, and have them phone it in to the specialty pharmacy," I command. (I know the names of both fertility pharmacies in NYC). He does and they do.
Then, all he has to do is trek over there with Spunx. And, oh yeah, PAY for it. Except it's a weekend, and we can't get ahold of anyone from the insurance company, and the pharmacy doesn't take the our new health insurance. So H had to pay full price for infertility meds. That took some doing.
So last night, I got my meds (all of them) right on time.
And the television broke.
And a co-worker died.
And I miss Mama.
And I cried so hard I gave myself hiccups.
This is not a smooth cycle.
Thursday, April 2, 2009
Tuesday, March 31, 2009
Everything Else
I know what it takes to get pregnant. Or, more exactly, I know what it takes to get me pregnant.
It takes being on a macro.biotic diet. Going without sugar and caffeine. Taking a busload of vitamins and supplements. Regular exercise. Positive thinking. Acupuncture. Chiropractor. Massage. Oh, and IVF. (Of course).
Most of which is hard to do when you have, um, a child.
I brought Spunx to an acupuncture appointment. (New insurance, different coverage, brand new acupuncturist). The acu refused to treat me since I had Spunx. "What will happen if he cried?"
Um. Yeah. Good point. (Even my regular acupuncturist gently says "a babysitter would be better...") The chiropractor doesn't care, and the masseuse has yet to be polled.
This is going to be difficult.
The diet is all me. I have no excuse for my failure here. It's been hard for me to constrain my diet. I have no willpower. A little a cheese, a little sugar, a decaf coffee and I'm a goner. It doesn't sound like a lot, but for me it is. (I don't know if I've ever mentioned, but I did innumerable IUIs. Double digits, I lost count IUIs. I got to compare how I responded to the same drugs with different lifestyles and diets. Trust me. I know of what I speak in this area...)
Crap. It's hard to go back to back to leaves and berries when W,hite C.astle has crept into your diet.
The supplements are easier. They're only pills, for crying out loud. Even *I* can manage to swallow a few times aday. It's the remembering that's a little difficult for me.
The exercise? EASY PEASY. Okay, not the "f.ertility y.oga" that I did the first time around, but I am constantly lugging, chasing or pushing Spunx. I'm not only at my pre-pregnancy weight, I'm six pounds under.
And as to the positive thinking... yeah. Working on that one next.
It takes being on a macro.biotic diet. Going without sugar and caffeine. Taking a busload of vitamins and supplements. Regular exercise. Positive thinking. Acupuncture. Chiropractor. Massage. Oh, and IVF. (Of course).
Most of which is hard to do when you have, um, a child.
I brought Spunx to an acupuncture appointment. (New insurance, different coverage, brand new acupuncturist). The acu refused to treat me since I had Spunx. "What will happen if he cried?"
Um. Yeah. Good point. (Even my regular acupuncturist gently says "a babysitter would be better...") The chiropractor doesn't care, and the masseuse has yet to be polled.
This is going to be difficult.
The diet is all me. I have no excuse for my failure here. It's been hard for me to constrain my diet. I have no willpower. A little a cheese, a little sugar, a decaf coffee and I'm a goner. It doesn't sound like a lot, but for me it is. (I don't know if I've ever mentioned, but I did innumerable IUIs. Double digits, I lost count IUIs. I got to compare how I responded to the same drugs with different lifestyles and diets. Trust me. I know of what I speak in this area...)
Crap. It's hard to go back to back to leaves and berries when W,hite C.astle has crept into your diet.
The supplements are easier. They're only pills, for crying out loud. Even *I* can manage to swallow a few times aday. It's the remembering that's a little difficult for me.
The exercise? EASY PEASY. Okay, not the "f.ertility y.oga" that I did the first time around, but I am constantly lugging, chasing or pushing Spunx. I'm not only at my pre-pregnancy weight, I'm six pounds under.
And as to the positive thinking... yeah. Working on that one next.
Monday, March 30, 2009
Here again
I'm in the waiting room, waiting. Waiting to be blooded, to be wanded, to get on the treadmill once again.
I have never been more terrified.
I keep trying to talk myself out of it, but logic doesn't help. I have a child; this shouldn't be as scarey as it is.
But it is.
Everything is pretty much the same as you'd expect. It's far too early in the morning, and I'm surrounded by sleepy, sullen people (mostly women). No one's happy, no one's ever happy to be here. Why is that? (okay, I know why.) I just wish that this felt... different.
I have never been more terrified.
I keep trying to talk myself out of it, but logic doesn't help. I have a child; this shouldn't be as scarey as it is.
But it is.
Everything is pretty much the same as you'd expect. It's far too early in the morning, and I'm surrounded by sleepy, sullen people (mostly women). No one's happy, no one's ever happy to be here. Why is that? (okay, I know why.) I just wish that this felt... different.
Sunday, March 22, 2009
Three Week Wait
That's how long its been since I posted. Wow, time really flies when... well, time really flies.
First, to all of you wrote and posted with your support: thanks. Thanks. Thanks. I love that you get it, that you're accepting and well, you get it. Thanks also to those who called H all sorts of lovely names (and you know who you are). It's sad how much I enjoyed that.
Second, you're right. H is trying to find himself and define himself now that he is no longer a son. No longer a caregiver. We had that conversation (prompted, largely, by comments and e-mails). And it was a good conversation. Enlightening, even. So thanks for getting involved: you helped strengthen my marriage.
First, to all of you wrote and posted with your support: thanks. Thanks. Thanks. I love that you get it, that you're accepting and well, you get it. Thanks also to those who called H all sorts of lovely names (and you know who you are). It's sad how much I enjoyed that.
Second, you're right. H is trying to find himself and define himself now that he is no longer a son. No longer a caregiver. We had that conversation (prompted, largely, by comments and e-mails). And it was a good conversation. Enlightening, even. So thanks for getting involved: you helped strengthen my marriage.
Sunday, March 1, 2009
All I need is sleep (and the will to go on)
So.
Last night I didn't get much sleep.
In case I hadn't mentioned, I'm working weekends now. New job, new boss, new responsibilities. New schedule. I'm working weekends because they've fired every third person in my department and it was put to me that I would either work weekends or not work. Which would you choose?
So, while H works a regulation Monday to Friday 9 to 5 schedule, I put in 14 hour days on Saturday and Sunday.
It sucks.
But—NEVER FEAR!—H has not let this stop his social life. It just that his social life no longer includes me. I have three days off a week; he regularly schedules activities (that don't include me) so I see him, total, for about 45 minutes per day. I have stopped being someone that he tries to make time for. (Was I ever?) I am just the babysitter he does not have to pay for.
In fact, next month H wants to take Spunx on a ski trip to Pennsylvania. Without me. Or, maybe, leave Spunks with a friend and still go on a ski trip to PA. Without me. (And if you're wondering, I don't have enough time off left to take that weekend).
Last night, there was a big party given by a friend of H's. So H got a sitter and went. Without me. And he didn't get home until 4:30AM. Leaving me to deal with Spunx nighttime feedings and fussiness (I take care of Spunks on the nights that H works, and the deal was that H would reciprocate).
Now, I'll skip over the "we're so broke that" type whines (as in, we're so broke that we can't afford the extra babysitting hours and we're so broke we can't afford a new filter for the air filter).
To get to work on time, I have to be up by 6:30AM. So usually, I'm turning in at 10:00PM.
Last night, I got to get to bed about 12:30AM. And was woken shortly after. Twice.
Now, I don't know about you, but lack of sleep makes me sad. As in depressed. As in I've already burst into tears twice today (and once last night, which was actually past midnight, so you could say that I've cried three times today if you were anal about such things).
And I'm starting to realize that H doesn't like me a hell of a lot. And that H would prefer life... Without me.
Last night I didn't get much sleep.
In case I hadn't mentioned, I'm working weekends now. New job, new boss, new responsibilities. New schedule. I'm working weekends because they've fired every third person in my department and it was put to me that I would either work weekends or not work. Which would you choose?
So, while H works a regulation Monday to Friday 9 to 5 schedule, I put in 14 hour days on Saturday and Sunday.
It sucks.
But—NEVER FEAR!—H has not let this stop his social life. It just that his social life no longer includes me. I have three days off a week; he regularly schedules activities (that don't include me) so I see him, total, for about 45 minutes per day. I have stopped being someone that he tries to make time for. (Was I ever?) I am just the babysitter he does not have to pay for.
In fact, next month H wants to take Spunx on a ski trip to Pennsylvania. Without me. Or, maybe, leave Spunks with a friend and still go on a ski trip to PA. Without me. (And if you're wondering, I don't have enough time off left to take that weekend).
Last night, there was a big party given by a friend of H's. So H got a sitter and went. Without me. And he didn't get home until 4:30AM. Leaving me to deal with Spunx nighttime feedings and fussiness (I take care of Spunks on the nights that H works, and the deal was that H would reciprocate).
Now, I'll skip over the "we're so broke that" type whines (as in, we're so broke that we can't afford the extra babysitting hours and we're so broke we can't afford a new filter for the air filter).
To get to work on time, I have to be up by 6:30AM. So usually, I'm turning in at 10:00PM.
Last night, I got to get to bed about 12:30AM. And was woken shortly after. Twice.
Now, I don't know about you, but lack of sleep makes me sad. As in depressed. As in I've already burst into tears twice today (and once last night, which was actually past midnight, so you could say that I've cried three times today if you were anal about such things).
And I'm starting to realize that H doesn't like me a hell of a lot. And that H would prefer life... Without me.
Saturday, February 28, 2009
Worst Mother in the World (Me)
Spunx burnt his hands on the oven door.
I had him in the kitchen, the oven was long off and there was a chair in front of the oven door. None of this mattered to my determined son as he rolled up and tried to open the oven. And in the process, gave himself first and second degree burns.
Wow, I suck
I had him in the kitchen, the oven was long off and there was a chair in front of the oven door. None of this mattered to my determined son as he rolled up and tried to open the oven. And in the process, gave himself first and second degree burns.
Wow, I suck
Tuesday, February 17, 2009
"P.icture E.merging o.n G.enetic R.isks of I.V.F"
From the N.ew Y.ork T.imes
Over the past 30 years, in vitro fertilization has been reassuringly safe. Millions of healthy children have been born and developed normally. And the first IVF baby, Louise Brown, born in England on July 25, 1978, now has her own child, 2-year-old Cameron, conceived without the technique.
But researchers have always wondered whether there might be subtle changes in an embryo that is grown for several days in a petri dish, as IVF embryos are — and, if so, whether would there be any consequences.
Now, with new epidemiological studies and new techniques that allow scientists to probe the genes of embryo cells, some tentative answers are starting to emerge.
The issues have nothing to do with the chances that a woman will have twins, triplets or even, as just happened in California, octuplets. Instead, they involve questions of whether there are changes in gene expression or in developmental patterns, which may or may not be obvious at birth.
For example, some studies indicate that there may be some abnormal patterns of gene expression associated with IVF and a possible increase in rare but devastating genetic disorders that appear to be directly linked to those unusual gene expression patterns. There also appears to be an increased risk of premature birth and of babies with low birth weight for their gestational age.
In November, the Centers for Disease Control and Prevention published a paper reporting that babies conceived with IVF, or with a technique in which sperm are injected directly into eggs, have a slightly increased risk of several birth defects, including a hole between the two chambers of the heart, a cleft lip or palate, an improperly developed esophagus and a malformed rectum.
The study involved 9,584 babies with birth defects and 4,792 babies without. Among the mothers of babies without birth defects, 1.1 percent had used IVF or related methods, compared with 2.4 percent of mothers of babies with birth defects.
The findings are considered preliminary, and researchers say they believe IVF does not carry excessive risks. There is a 3 percent chance that any given baby will have a birth defect.
But the real question — what is the chance that an IVF baby will have a birth defect? — has not been definitively answered. That would require a large, rigorous study that followed these babies. The C.D.C. study provides comparative risks but not absolute risks.
Yet even though the risks appear to be small, researchers who are studying the molecular biology of embryos grown in petri dishes say they would like a better understanding of what happens, so they can improve the procedure and allow couples to make more informed decisions.
“There is a growing consensus in the clinical community that there are risks,” said Richard M. Schultz, associate dean for the natural sciences at the University of Pennsylvania. “It is now incumbent on us to figure out what are the risks and whether we can do things to minimize the risks.”
And although the questions are well known, the discussion has been largely confined to scientists, said Dr. Elizabeth Ginsburg, president of the Society for Assisted Reproductive Technology.
Dr. Ginsburg, who is the medical director of in vitro fertilization at Brigham and Women’s Hospital in Boston, says her center’s consent forms mention that there might be an increased risk for certain rare genetic disorders. But, she says, none of her patients have been dissuaded.
Richard G. Rawlins, who directs the in vitro fertilization and assisted reproduction laboratories at the Rush Centers for Advanced Reproductive Care in Chicago, said that when he spoke to patients he never heard questions about growing embryos in the laboratory and the possible consequences.
“I have never had a patient ask me anything” about it, he said, adding, “For that matter, not many doctors have ever asked, either.”
Dr. Andrew Feinberg, a professor of medicine and genetics at Johns Hopkins, became concerned about the lack of information about IVF eight years ago when he and a colleague, Dr. Michael R. DeBaun, were studying changes in gene expression that can lead to cancer.
Their focus was on children with Beckwith-Wiedemann syndrome, characterized by a 15 percent risk of childhood cancers of the kidney, liver or muscle; an overgrowth of cells in the kidney and other tissues; and other possible abnormalities, among them a large tongue, abdominal-wall defects and low levels of blood sugar in infancy.
The syndrome, Dr. Feinberg and Dr. DeBaun found, was often caused by changes in the expression of a cluster of genes, and those changes also are found in colon and lung cancers. Children with those gene alterations had a 50 percent risk of the childhood cancers. The normal risk is less than 1 in 10,000.
The two investigators recruited children with the disorder, following them and studying them in their clinic. Then, several mothers in the study who had had IVF asked the researchers: Was it possible that the fertility treatments had caused Beckwith-Wiedemann syndrome?
That prompted Dr. Feinberg and Dr. DeBaun to investigate the prevalence of IVF and related methods in the pregnancies that resulted in children with Beckwith-Wiedemann syndrome.
Their conclusion, and the conclusion from at least half a dozen other large studies, was that there were about 10 times more parents who had used IVF or related methods than would be expected.
Another disorder caused by abnormal gene expression, Angelman syndrome, also is suspected of being linked to IVF. It involves severe mental retardation, motor defects, an inability to speak and a cheerful disposition. The disorders are rare. Beckwith-Wiedemann occurs just once in 13,000 children, and Angelman occurs about once in every 10,000 children.
Why, researchers ask, would growing embryos in petri dishes elicit changes in gene expression? And if there are changes, could they alter the laboratory conditions so those gene expression changes do not occur?
One place to look might be the broth, known as the culture medium, in which embryos grow. From the start of IVF, scientists knew that the composition of the broth affected how quickly embryos grew, Dr. Rawlins said. And they knew that embryos, both animal and human, grew much more slowly in the lab than they did in the body.
One thing the culture medium provides is chemicals that can be used to add methyl groups to genes. The presence, or absence, of the methyl groups can control whether genes are active or not, a process known as epigenetics. Epigenetic changes not only cause rare disorders like Beckwith-Wiedemann syndrome but also are associated with low-birth-weight babies and an increased risk of a variety of cancers. That does not mean that growing embryos in petri dishes will have such effects, but it does raise questions about what is known about the procedure.
Dr. George Daley, a researcher at Harvard Medical School studying human embryonic stem cells, said the questions also extended to those cells, which are taken from human embryos and grown in petri dishes. He has seen epigenetic changes in stem cells but is not sure what they mean.
“My major concern is that we don’t have enough information, or the tools to measure epigenetic stability,” he said. “It may or may not be relevant to the safety of the cells, though I suspect it is.”
But figuring out what, if anything, in the culture medium might adversely affect embryo growth and development may not be easy, Dr. Feinberg said.
Dr. Ginsburg said the Society for Assisted Reproductive Technology discussed whether to ask IVF centers to report what media they were using to grow their embryos. But, she said, “programs use multiple media, and it is very common for programs to switch from one media to another.”
If mouse embryos are even close to reflecting what can happen with humans, then there is no question that gene expression can be altered by growing embryos in a laboratory, Dr. Schultz says.
He and several others spent years asking whether there were gene expression changes in mouse embryos that are grown in the laboratory — there are — and whether they could see behavioral changes in the animals. They did.
For example, the investigators gave mice a test that required remembering the location of a platform hidden by opaque water. The IVF mice had no trouble learning where the platform was, but were more likely to forget what they had learned, Dr. Schultz found.
In another test, which measured a fear response when mice are in the open, IVF mice lacked the normal caution and fear that non-IVF mice are born with.
“They are changes,” Dr. Schultz said, of the test results. “And the only difference is that they were cultured,” meaning that the mice started out as embryos in a petri dish.
Along with the behavioral changes were changes in the methylation of genes — epigenetic changes, Dr. Schultz reports. “I am suspicious that manipulation and culturing of embryos is a contributing factor,” he adds.
But following babies born after IVF or intracytoplasmic sperm injection is not easy. And if problems emerge from epigenetic changes, they may not be apparent until adulthood or middle or old age.
“When you send questionnaires, the tendency is for the couple who may have had a problem or who think they have a problem to answer that questionnaire,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at New York Weill Cornell Center. Those who do not respond tend to be parents whose children seem fine, skewing the data.
Dr. Rosenwaks’s group largely paid for its own studies. They conclude, he said, that “even if there was a slight increase in abnormalities, the rate was not much higher than in the general population.”
Others, like Dr. Alistair Sutcliffe of University College London, say the field is crying out for more information on the risks.
“I talk on this topic worldwide,” he said. “My talks over time are based on the known literature. And I have gradually become slightly less optimistic about the things that are known about the health of the children” born after IVF and related procedures.
“Obviously, more knowledge is required,” Dr. Sutcliffe said. “The perfect study hasn’t been done.”
A version of this article appeared in print on February 17, 2009, on page D1 of the New York edition.
Over the past 30 years, in vitro fertilization has been reassuringly safe. Millions of healthy children have been born and developed normally. And the first IVF baby, Louise Brown, born in England on July 25, 1978, now has her own child, 2-year-old Cameron, conceived without the technique.
But researchers have always wondered whether there might be subtle changes in an embryo that is grown for several days in a petri dish, as IVF embryos are — and, if so, whether would there be any consequences.
Now, with new epidemiological studies and new techniques that allow scientists to probe the genes of embryo cells, some tentative answers are starting to emerge.
The issues have nothing to do with the chances that a woman will have twins, triplets or even, as just happened in California, octuplets. Instead, they involve questions of whether there are changes in gene expression or in developmental patterns, which may or may not be obvious at birth.
For example, some studies indicate that there may be some abnormal patterns of gene expression associated with IVF and a possible increase in rare but devastating genetic disorders that appear to be directly linked to those unusual gene expression patterns. There also appears to be an increased risk of premature birth and of babies with low birth weight for their gestational age.
In November, the Centers for Disease Control and Prevention published a paper reporting that babies conceived with IVF, or with a technique in which sperm are injected directly into eggs, have a slightly increased risk of several birth defects, including a hole between the two chambers of the heart, a cleft lip or palate, an improperly developed esophagus and a malformed rectum.
The study involved 9,584 babies with birth defects and 4,792 babies without. Among the mothers of babies without birth defects, 1.1 percent had used IVF or related methods, compared with 2.4 percent of mothers of babies with birth defects.
The findings are considered preliminary, and researchers say they believe IVF does not carry excessive risks. There is a 3 percent chance that any given baby will have a birth defect.
But the real question — what is the chance that an IVF baby will have a birth defect? — has not been definitively answered. That would require a large, rigorous study that followed these babies. The C.D.C. study provides comparative risks but not absolute risks.
Yet even though the risks appear to be small, researchers who are studying the molecular biology of embryos grown in petri dishes say they would like a better understanding of what happens, so they can improve the procedure and allow couples to make more informed decisions.
“There is a growing consensus in the clinical community that there are risks,” said Richard M. Schultz, associate dean for the natural sciences at the University of Pennsylvania. “It is now incumbent on us to figure out what are the risks and whether we can do things to minimize the risks.”
And although the questions are well known, the discussion has been largely confined to scientists, said Dr. Elizabeth Ginsburg, president of the Society for Assisted Reproductive Technology.
Dr. Ginsburg, who is the medical director of in vitro fertilization at Brigham and Women’s Hospital in Boston, says her center’s consent forms mention that there might be an increased risk for certain rare genetic disorders. But, she says, none of her patients have been dissuaded.
Richard G. Rawlins, who directs the in vitro fertilization and assisted reproduction laboratories at the Rush Centers for Advanced Reproductive Care in Chicago, said that when he spoke to patients he never heard questions about growing embryos in the laboratory and the possible consequences.
“I have never had a patient ask me anything” about it, he said, adding, “For that matter, not many doctors have ever asked, either.”
Dr. Andrew Feinberg, a professor of medicine and genetics at Johns Hopkins, became concerned about the lack of information about IVF eight years ago when he and a colleague, Dr. Michael R. DeBaun, were studying changes in gene expression that can lead to cancer.
Their focus was on children with Beckwith-Wiedemann syndrome, characterized by a 15 percent risk of childhood cancers of the kidney, liver or muscle; an overgrowth of cells in the kidney and other tissues; and other possible abnormalities, among them a large tongue, abdominal-wall defects and low levels of blood sugar in infancy.
The syndrome, Dr. Feinberg and Dr. DeBaun found, was often caused by changes in the expression of a cluster of genes, and those changes also are found in colon and lung cancers. Children with those gene alterations had a 50 percent risk of the childhood cancers. The normal risk is less than 1 in 10,000.
The two investigators recruited children with the disorder, following them and studying them in their clinic. Then, several mothers in the study who had had IVF asked the researchers: Was it possible that the fertility treatments had caused Beckwith-Wiedemann syndrome?
That prompted Dr. Feinberg and Dr. DeBaun to investigate the prevalence of IVF and related methods in the pregnancies that resulted in children with Beckwith-Wiedemann syndrome.
Their conclusion, and the conclusion from at least half a dozen other large studies, was that there were about 10 times more parents who had used IVF or related methods than would be expected.
Another disorder caused by abnormal gene expression, Angelman syndrome, also is suspected of being linked to IVF. It involves severe mental retardation, motor defects, an inability to speak and a cheerful disposition. The disorders are rare. Beckwith-Wiedemann occurs just once in 13,000 children, and Angelman occurs about once in every 10,000 children.
Why, researchers ask, would growing embryos in petri dishes elicit changes in gene expression? And if there are changes, could they alter the laboratory conditions so those gene expression changes do not occur?
One place to look might be the broth, known as the culture medium, in which embryos grow. From the start of IVF, scientists knew that the composition of the broth affected how quickly embryos grew, Dr. Rawlins said. And they knew that embryos, both animal and human, grew much more slowly in the lab than they did in the body.
One thing the culture medium provides is chemicals that can be used to add methyl groups to genes. The presence, or absence, of the methyl groups can control whether genes are active or not, a process known as epigenetics. Epigenetic changes not only cause rare disorders like Beckwith-Wiedemann syndrome but also are associated with low-birth-weight babies and an increased risk of a variety of cancers. That does not mean that growing embryos in petri dishes will have such effects, but it does raise questions about what is known about the procedure.
Dr. George Daley, a researcher at Harvard Medical School studying human embryonic stem cells, said the questions also extended to those cells, which are taken from human embryos and grown in petri dishes. He has seen epigenetic changes in stem cells but is not sure what they mean.
“My major concern is that we don’t have enough information, or the tools to measure epigenetic stability,” he said. “It may or may not be relevant to the safety of the cells, though I suspect it is.”
But figuring out what, if anything, in the culture medium might adversely affect embryo growth and development may not be easy, Dr. Feinberg said.
Dr. Ginsburg said the Society for Assisted Reproductive Technology discussed whether to ask IVF centers to report what media they were using to grow their embryos. But, she said, “programs use multiple media, and it is very common for programs to switch from one media to another.”
If mouse embryos are even close to reflecting what can happen with humans, then there is no question that gene expression can be altered by growing embryos in a laboratory, Dr. Schultz says.
He and several others spent years asking whether there were gene expression changes in mouse embryos that are grown in the laboratory — there are — and whether they could see behavioral changes in the animals. They did.
For example, the investigators gave mice a test that required remembering the location of a platform hidden by opaque water. The IVF mice had no trouble learning where the platform was, but were more likely to forget what they had learned, Dr. Schultz found.
In another test, which measured a fear response when mice are in the open, IVF mice lacked the normal caution and fear that non-IVF mice are born with.
“They are changes,” Dr. Schultz said, of the test results. “And the only difference is that they were cultured,” meaning that the mice started out as embryos in a petri dish.
Along with the behavioral changes were changes in the methylation of genes — epigenetic changes, Dr. Schultz reports. “I am suspicious that manipulation and culturing of embryos is a contributing factor,” he adds.
But following babies born after IVF or intracytoplasmic sperm injection is not easy. And if problems emerge from epigenetic changes, they may not be apparent until adulthood or middle or old age.
“When you send questionnaires, the tendency is for the couple who may have had a problem or who think they have a problem to answer that questionnaire,” said Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility at New York Weill Cornell Center. Those who do not respond tend to be parents whose children seem fine, skewing the data.
Dr. Rosenwaks’s group largely paid for its own studies. They conclude, he said, that “even if there was a slight increase in abnormalities, the rate was not much higher than in the general population.”
Others, like Dr. Alistair Sutcliffe of University College London, say the field is crying out for more information on the risks.
“I talk on this topic worldwide,” he said. “My talks over time are based on the known literature. And I have gradually become slightly less optimistic about the things that are known about the health of the children” born after IVF and related procedures.
“Obviously, more knowledge is required,” Dr. Sutcliffe said. “The perfect study hasn’t been done.”
A version of this article appeared in print on February 17, 2009, on page D1 of the New York edition.
Sunday, February 15, 2009
Stuff to Knock You Up (or Out) (UPDATED!)
Help me (please) compile a list of stupid stuff that (allegedly) helps in conception and/or implantation
BEYOND USELESS
• Just Relax!
• Get enough sleep
• "Stop thinking about it and it will happen"
CONCEPTION
• Accupuncture
• Aspirin
• CoQ10
• D.H.E.A
• Femoral massage
• NO Caffeine
• Cough Syrup
• Red Clover
IMPLANTATION
• Pineapple
Anyone?
I'm doing this mostly for myself, a little to impart to a friend who is starting new into the land of IF and IVF.
Thanking you in advance for your cooperation...
:)
BEYOND USELESS
• Just Relax!
• Get enough sleep
• "Stop thinking about it and it will happen"
CONCEPTION
• Accupuncture
• Aspirin
• CoQ10
• D.H.E.A
• Femoral massage
• NO Caffeine
• Cough Syrup
• Red Clover
IMPLANTATION
• Pineapple
Anyone?
I'm doing this mostly for myself, a little to impart to a friend who is starting new into the land of IF and IVF.
Thanking you in advance for your cooperation...
:)
Saturday, February 14, 2009
Apologies from THAT Woman
Friday, I had an appointment at my RE. (The water torture test--I can't remember the name for the life of me).
Friday's normally a day off of work for me, and in these tight times, a day off of work is a day without childcare.
Which meant I took Spunx to the RE. And in doing so, became THAT Woman. The one who so thoughtlessly flaunts her baby.
I apologize.
Not only for me, but for all of the rest of them.
I am sorry.
If it's any consolation, and it probably won't be, I completely wrenched my back hauling the stroller up the steps. And the back pain lingers even now.
But I know. No consolation.
I'd even like to apologize even though there were three other mothers with children there (two infants in strollers, one about six). I did not feel validated or comforted or anything like that when I saw them. Frankly, I was horrified. How could they be so cavalier? So thoughtless? WTH?
Friday's normally a day off of work for me, and in these tight times, a day off of work is a day without childcare.
Which meant I took Spunx to the RE. And in doing so, became THAT Woman. The one who so thoughtlessly flaunts her baby.
I apologize.
Not only for me, but for all of the rest of them.
I am sorry.
If it's any consolation, and it probably won't be, I completely wrenched my back hauling the stroller up the steps. And the back pain lingers even now.
But I know. No consolation.
I'd even like to apologize even though there were three other mothers with children there (two infants in strollers, one about six). I did not feel validated or comforted or anything like that when I saw them. Frankly, I was horrified. How could they be so cavalier? So thoughtless? WTH?
The Dog Ate My Blog Post
Yeah.
I owe so many people e-mail. And those I don't owe e-mails, I owe phone calls. But for most (including me) I owe blog updates.
So. We (H, Spunketta and I) for through the holiday season (Christmas, New Years and Three Kings) fairly well.
And then.
Then it was my birthday. Then it was MLK day, and we could remember exactly where we were the year before.
And... we got sad. I got sad. And I missed Mama.
And then we got sick. It was bit of a bucket brigade; H got sick first, then got me sick. I got better, but by then Spunx was sick. After Spunx got better, I was sick again. I got better, but then H was ill. And then Spunx was sick again, and sick BIG. Calling the pediatrician big.
So, on top of being sad, I was scared and exhausted.
And THEN they laid some people off at work. They've laid people off three times since I've returned from maternity leave. So the feeling at work is STRESSED, to say the least. (Same is true at H's job -- two rounds of layoffs).
And then.
And then I posted.
I owe so many people e-mail. And those I don't owe e-mails, I owe phone calls. But for most (including me) I owe blog updates.
So. We (H, Spunketta and I) for through the holiday season (Christmas, New Years and Three Kings) fairly well.
And then.
Then it was my birthday. Then it was MLK day, and we could remember exactly where we were the year before.
And... we got sad. I got sad. And I missed Mama.
And then we got sick. It was bit of a bucket brigade; H got sick first, then got me sick. I got better, but by then Spunx was sick. After Spunx got better, I was sick again. I got better, but then H was ill. And then Spunx was sick again, and sick BIG. Calling the pediatrician big.
So, on top of being sad, I was scared and exhausted.
And THEN they laid some people off at work. They've laid people off three times since I've returned from maternity leave. So the feeling at work is STRESSED, to say the least. (Same is true at H's job -- two rounds of layoffs).
And then.
And then I posted.
Sunday, January 4, 2009
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